Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Nov 2009
Randomized Controlled Trial Comparative StudyPostoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block.
Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children. ⋯ peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.
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Rev Bras Anestesiol · Nov 2009
Randomized Controlled Trial Comparative StudySupraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine.
Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local anesthetics. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine). However, the anesthetic efficacy (sensorial and motor blockades) of levobupivacaine in neuroaxis blocks has been debated. The objective of this study was to demonstrate the anesthetic efficacy of levobupivacaine in brachial plexus block, using the perivascular subclavian approach, by comparing it to racemic bupivacaine. ⋯ The anesthetic efficacy of levobupivacaine in brachial plexus block was similar to that of the racemic solution commonly used.
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Rev Bras Anestesiol · Nov 2009
Comparative StudyDose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women.
The effect of BMI on the spread of intrathecal bupivacaine is controversial. This study assessed the ED95 of intrathecal bupivacaine for elective cesarean delivery in obese and normal weight women. ⋯ If single shot spinal anesthesia is used for cesarean delivery, obese and normal weight patients should receive similar doses of hyperbaric bupivacaine. Although in our study the effective dose 95% could not be precisely determined, it is possible to state that it is at least 11.49 mg.
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Rev Bras Anestesiol · Nov 2009
Case ReportsTotal intravenous anesthesia with target-controlled infusion of remifentanil and propofol for ablation of atrial fibrillation.
Although ablation of atrial fibrillation (AF) is common in other centers, among us it is a new procedure. The choice of anesthesia, monitors, and anesthesiologic care for this procedure performed outside the surgical center has not been described. The objective of this report was to describe an anesthesia technique for ablation of AF. ⋯ Total intravenous anesthesia for ablation of AF can be a safe option considering the lack of electrophysiological changes in accessory pathways. The literature on this subject is scarce and new publications could justify, or not, this type of anesthesia during ablation of AF.
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Rev Bras Anestesiol · Nov 2009
Influence of angiotensin-converting enzyme inhibitors on hypotension after anesthetic induction: is the preoperative discontinuation of this drug necessary?
The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective of the present study was to evaluate the influence of the preoperative use of ACE inhibitors on the development of hypotension during anesthesia. ⋯ We did not observe an association between the use of ACE inhibitors and hypotension during anesthesia. The authors considered that the recommendation to discontinue ACE inhibitors on the day before the surgery should be reviewed. Other studies are necessary to confirm those results.